1902957764 NPI number — DR. MALAK PHILIPPE ZACCA SHAMMAS MD

Table of content: DR. MALAK PHILIPPE ZACCA SHAMMAS MD (NPI 1902957764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902957764 NPI number — DR. MALAK PHILIPPE ZACCA SHAMMAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZACCA SHAMMAS
Provider First Name:
MALAK
Provider Middle Name:
PHILIPPE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902957764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 492463
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90049-8463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-271-6229
Provider Business Mailing Address Fax Number:
310-271-9139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9400 BRIGHTON WAY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90210-4714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-271-6229
Provider Business Practice Location Address Fax Number:
310-271-9139
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  G80339 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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